两种消毒剂在内镜消毒机上对内镜模拟现场消毒效果观察

为比较2种消毒剂对内镜模拟现场消毒效果,采用人工染菌试验方法对雾化熏蒸法和冲洗法消毒内镜的效果进行了观察。结果,在自动消毒机上,用20g/L戊二醛和700mg/L二氧化氯消毒剂冲洗作用5min,对内镜外壁上指标菌清除率达到100%;对内腔冲洗作用30min,2种消毒剂对指标菌清除率分别为86.30%和99.99%。用20g/L戊二醛和700mg/L二氧化氯消毒剂对内镜的内腔雾化熏蒸消毒60min,对指标菌清除率分别为30.51%和44.26%。结论,用20g/L戊二醛和700mg/L二氧化氯消毒剂经自动内镜消毒机冲洗消毒对内镜外壁可达到消毒要求,对内镜的内腔只有二氧化氯可达到消毒要求;用雾化熏蒸法消毒,两种消毒剂均达不到消毒要求。     

上海市医院内窥镜污染与消毒现状调查

为了解上海市医院内窥镜的使用状况及其污染与消毒现状,对30所医院的5种常用内窥镜进行了调查与采样检测。结果,内窥镜使用场地符合率为85.88％,用于肝炎、结核等特殊传染病人检查的内窥镜专用率为69.41％,使用消毒剂正确率为90.59％,内窥镜消毒、灭菌作用时间符合率为45.88％,仅2.35％活检钳进行灭菌;内窥镜消毒、灭菌合格率为84.42％（168/199）,胃肠镜水瓶水检测合格率为41.27％（26/63）。胃镜污染微生物主要为金黄色葡萄球菌、HBsAg、绿脓杆菌、大肠杆菌及分枝杆菌。胃肠镜水瓶水中尚检出绿脓杆菌。内窥镜消毒不合格主要与作用时间不足、消毒剂含量不够有关;胃镜污染分枝杆菌则与其消毒后用自来水冲洗有关。因此,应严格掌握消毒剂用量、消毒与灭菌作用时间、以及消毒后冲洗用水。     

广州市40所医院内镜清洗消毒管理现况调查

目的了解广州市不同等级医院内镜清洗消毒管理现况,发现存在问题,以便改进内镜消毒质量。方法采用问卷调查与现场调查相结合的方法,对广州市不同等级开展胃肠镜诊疗工作的40家综合医院内镜清洗消毒管理现状进行调查。结果清洗人员主要为护理人员和聘用工人;有72.5%的医院由护理人员负责内镜的清洗消毒工作,27.5%的医院由聘用工人负责内镜清洗消毒;其中有24.2%属兼职清洗人员。有70%的医院能将内镜诊疗与清洗消毒分室进行,只有35%的三级医院内镜清洗消毒室面积≥20 m2。内镜室基本清洗消毒设施齐全的医院只占37.5%,三级医院占60%配置齐全,所有二级医院消毒设施配置均不齐全。40所医院中,仅有5所医院能对消毒剂浓度进行择机检测。结论广州市医院内镜清洗消毒管理现状不理想,内镜超负荷使用,消毒设施配置不齐全,需要加强管理。     

胃肠镜消毒效果及其影响因素的研究

目的了解广东省医院胃肠镜消毒效果及其影响因素。方法采用现场采样和实验室检测方法对省内32所医院的胃肠镜使用和消毒现场进行调查。结果胃肠镜检查室的通风状况可能是影响胃肠镜消毒效果的危险因素;消毒后的胃肠镜的储存条件和清洗消毒人员的培训内容可能是影响胃肠镜消毒效果的保护因素。用清洁毛刷彻底刷洗活检孔道、用注射器抽吸酶洗液冲洗送气送水管道及活检孔道、用酶洗液浸泡的时间、刷洗钳瓣内面和关节处和清洗后并擦干可能是影响胃肠镜消毒效果的保护因素。按照关键影响因素进行的胃肠镜模拟现场消毒试验结果表明,可将传统方法的消毒合格率78.33%提高到98.33%。结论严格控制胃肠镜清洗消毒程序中的有关因素,可明显改善胃肠镜消毒效果。     

Endoscope disinfection by ortho-phthalaldehyde in a clinical setting: an evaluation of reprocessing time and costs compared with glutaraldehyde.

Ortho-phthalaldehyde provides high-level disinfection in 12 minutes at room temperature (20 degrees C). To determine whether the endoscopy unit at Massachusetts General Hospital could cost-effectively increase endoscope throughput and decrease delayed procedures while maintaining biocidal efficacy with heavy use, ortho-phthalaldehyde solution (0.55% w/v) was used for high-level disinfection in place of glutaraldehyde in the unit's five automatic endoscope reprocessors. During this 38-day study, 1,839 endoscopes were processed in 1,201 cycles. Each machine ran an average of 80 disinfection cycles in each of three consecutive periods. The shorter disinfection time of ortho-phthalaldehyde (12 minutes) resulted in an average savings of 53 hours in disinfection time per study period for the five processors when compared with glutaraldehyde's 20-minute disinfection time.Ortho-phthalaldehyde costs more per gallon than glutaraldehyde ($31.03 versus $13.20). This higher cost would be offset, however, by additional time savings resulting from the fact that compared with glutaraldehyde, ortho-phthalaldehyde is faster-acting and a mixing and activation step is not required. In addition, testing prior to each cycle verified that despite heavy use, ortho-phthalaldehyde solution remained efficacious, lasting through an average of 80 cycles, whereas glutaraldehyde only lasts for an average of 40 cycles. Test strips showed the concentration of ortho-phthalaldehyde in the reprocessors remained above the minimum effective concentration for the entire 14-day maximal reuse period. Additional microbiological efficacy testing of spent solution diluted to its minimum effective concentration demonstrated the solution remained tuberculocidal in tests with Mycobacterium bovis.     

乌鲁木齐市医院内镜消毒现状调查

目的了解乌鲁木齐市医疗机构内镜污染和消毒现状,改进和提高内镜消毒管理。方法采用现场检查和采样检测方法,对全市医疗机构内镜消毒管理情况进行调查。结果部分医疗机构无独立的清洗消毒室,内镜室环境卫生质量合格率为57.14%。内镜清洗消毒槽不用流动水、刷洗步骤不合格,内镜清洗消毒操作方法合格率为70%;清洗消毒时间符合率为65.71%;内镜消毒效果平均合格率为68.09%。结论乌鲁木齐市医疗机构内镜消毒仍存在不少问题,硬件设施和操作规范都需要改进和提高。     

上海市某区消化内镜消毒现状调查

目的了解消化内镜消毒质量状况,以便加强内镜消毒质量管理。方法采用现场调查方法,对上海市某区医疗机构消化内镜消毒质量进行了检查。结果所调查的7家医院中,4家一级医院只开展胃镜诊疗项目,3家二级医院开展了多种消化内镜诊疗项目,多数医院能做到清洗消毒与诊室分开。7家医院都配备了内镜专用清洗槽,但超声清洗器及其他相关设施配备不齐全。7所医院中有6所使用20 g/L戊二醛浸泡消毒内镜,只有4所医院对清洗消毒后的内镜用无菌水冲洗。拥有内镜的二级以下医疗机构多数不具备消毒效果监测能力。结论拥有内镜的基层医疗机构硬件设施和软件管理水平都比较低,清洗消毒效果得不到保证。     

湖北省部分医院内镜清洗消毒状况调查报告

为加强医院内镜清洗消毒质量管理,贯彻《内镜清洗消毒技术操作规范》,采用现场抽样和检测方法,对全省医疗机构内镜清洗消毒情况进行了调查。结果,内镜室一般管理合格率波动在47.4%~96%;内镜清洗消毒处理程序合格率多数在50%左右。使用多酶洗液清洗内镜的医院约占40%;有20%的医院清洗活检孔道方法不正确。内镜消毒灭菌处理方法总合格率仅49%,其中纤支镜消毒操作合格率只有15.8%,腹腔镜灭菌操作合格率也只有60%。用压力蒸汽灭菌法对活检钳进行灭菌处理者仅占17.4%。结论,湖北省医院内镜消毒管理存在问题,多数医院内镜消毒灭菌处理程序和方法不正确。     

不同消毒方法对胃肠镜的消毒效果比较

目的观察不同消毒方法对胃肠镜的清洗消毒效果,确保内镜清洗消毒质量。方法采用冲洗法采样和细菌定量检验方法,对两种清洗消毒方法对胃肠镜清洗消毒效果进行了比较检测。结果在清洗干净的基础上,将1条胃镜浸泡于20 g/L戊二醛消毒液内消毒10 min,消毒效果合格率为97.14%;将2条胃镜同时浸泡于20 g/L戊二醛消毒液内消毒10 min,消毒效果合格率为84.38%。将1条肠镜浸泡于20 g/L戊二醛消毒液内消毒15 min,消毒效果合格率为100%;将2条肠镜同时浸泡于20 g/L戊二醛消毒液内消毒15 min,消毒效果合格率为66.67%。结论用戊二醛消毒液浸泡消毒胃肠镜,最好每次浸泡消毒1条胃镜或肠镜,能够确保消毒质量。     

四种全自动内镜消毒机对内镜消毒效果的比对观察

目的比较四种全自动内镜清洗消毒机对内镜消毒效果。方法采用实验室和模拟现场试验方法进行了比较检测。结果用超声雾化型自动清洗内镜消毒机,配合20.7g/L戊二醛雾化熏蒸3min,对染于聚四氟乙烯管道内壁载体上枯草杆菌黑色变种芽孢的平均清除率为93.21%,对内镜活检通道和镜身表面污染的枯草杆菌黑色变种芽孢的清除率分别为16.7%和73.3%。用SY-600型全自动内镜清洗消毒机,配合20.1g/L戊二醛消毒液冲洗10min,对染于聚四氟乙烯管道内壁载体上枯草杆菌黑色变种芽孢的平均清除率为99.94%,对内镜活检通道和镜身表面污染枯草杆菌黑色变种芽孢的清除率分别为86.7%和100%。用HY-0610全自动内窥镜清洗机,配合507mg/L过氧乙酸消毒液冲洗5min;用WAYWIN-2000型医用内镜灭菌器,配合1179mg/L过氧乙酸消毒液冲洗10min;对染于聚四氟乙烯管道内壁载体上和污染于内镜活检通道及镜身表面的枯草杆菌黑色变种芽孢的清除率均达到100%。结论以戊二醛为消毒剂的全自动内镜清洗消毒机,冲洗的消毒方式明显优于超声雾化,但均达不到消毒合格要求;以过氧乙酸为消毒剂的全自动内镜清洗消毒机对内镜管道和外壁均可达到消毒要求。     

EMS Provider Compliance with Infection Control Recommendations Is Suboptimal

Abstract

Introduction. Standard precautions are disease transmission prevention strategies recommended by both the World Health Organization (WHO) and by the Centers for Disease Control and Prevention (CDC). Emergency medical services (EMS) personnel are expected to utilize standard precautions. Methods. This was a prospective observational study of the use of standard precautions by EMS providers arriving at a large urban emergency department (ED). Research assistants (RAs) observed EMS crews throughout their arrival and delivery of patients and recorded data related to the use of gloves, hand hygiene, and equipment disinfection. Results. A total of 423 EMS deliveries were observed, allowing for observation of 899 EMS providers. Only 512 (56.9%) EMS providers arrived wearing gloves. Hand washing was observed in 250 (27.8%) of providers. Reusable equipment disinfection was noted in only 31.6% of opportunities. The most commonly disinfected item was the stretcher (55%). Conclusion. EMS provider compliance with standard precautions and equipment disinfection recommendations is suboptimal. Strategies must be developed to improve EMS provider compliance with internationally recognized infection control guidelines.     

Infectious complications associated with gastrointestinal endoscopy

Infectious complications resulting from endoscopy rarely occur. This is probably due as much to the efficiency of the gastrointestinal immune system as to effective endoscope disinfection practices. The low incidence may also represent the difficulty linking infections to endoscopy. Recent reports of probable interpersonal transmission of hepatitis C infection during colonoscopy has heightened this concern. This article examines the documented cases of endoscopy related infections and reviews the risk factors for these infections and details guidelines which have been designed to keep the incidence of these complications low.     

天津市部分医院消化内镜消毒状况调查

目的了解天津市各级医疗机构消化内镜消毒状况,加强医院感染控制工作。方法参照《内窥镜清洗消毒技术操作规范》,对16所医疗机构消化内镜进行了抽样检验和问卷调查。结果在16所不同级别医疗机构中,全部都建立了内镜管理制度,接受过内镜清洗消毒和医院感染管理相关知识培训的从业人员占93.75%。有81.25%的消化内镜室设有独立的洗消间,通风状况良好者占62.75%。有93.75%的消化内镜诊室备有高压气枪、烘干机等专用干燥设备。消化内镜消毒质量总平均合格率为87.10%。结论天津市各级医院消化内镜消毒管理比较规范,但在某些环节上仍存在一些问题,消毒质量有待提高。     

Infection control during gastrointestinal endoscopy

Infection-control issues during gastrointestinal endoscopy, which are becoming increasingly important, can generally be divided into three major areas: (1) infectious complications resulting from a patient's own microbial flora (autologous), (2) infections transmitted from patient to patient by way of the endoscope (exogenous), and (3) infections transmitted between the patient and the health-care provider. The mean frequency of postprocedure bacteremia ranges from 0.5% for flexible sigmoidoscopy to 2.2% for colonoscopy, 4.2% for esophagogastroduodenoscopy, 8.9% for variceal ligation, 11% for endoscopic retrograde cholangiopancreatography, 15.4% for variceal sclerotherapy, and 22.8% for esophageal dilation. Although postprocedure bacteremia is not uncommon, it seldom results in infectious complications. Exogenous infections transmitted during endoscopy, which are extremely rare, generally result from failure to follow accepted guidelines for the cleaning and disinfection of gastrointestinal endoscopes, underscoring the importance of meticulous attention to endoscope reprocessing. Finally, although the risk of patient-staff transmission of infection is also rare, standard infection-control recommendations are important in protecting both patients and health-care providers.     

Anthrax: is there a risk of cross-infection during endoscopy?

Bacillus anthracis is a large, gram-positive, spore-forming bacterium responsible for human anthrax. Review of the medical literature indicates specific instrument reprocessing instructions addressing the prevention of B. anthracis transmission are limited. Although nosocomial anthrax infection has not been reported, strict adherence to well-established instrument reprocessing guidelines for cleaning and high-level disinfection is recommended to prevent patient-to-patient transmission of B. anthracis (or any other pathogen) via gastrointestinal endoscopes or bronchoscopes. All liquid chemical sterilants labeled for high-level disinfection of endoscopes would be expected to destroy B. anthracis. Additional instrument cleaning or disinfection procedures appear to be unnecessary. Reprocessing the endoscope immediately following the procedure is emphasized.     

Endoscope reprocessing and repair costs

Endoscope reprocessing and repair are important factors in regard to patient safety, optimal endoscope function, and costs. Endoscope reprocessing requires high level disinfection. There are three steps in reprocessing; mechanical cleaning, disinfection, and that is followed by rinsing and drying. The most critical step is mechanical cleaning which results in a 10 (4) reduction in microbial contamination or bioburden. Improper cleaning can overwhelm high-level disinfection regardless of subsequent steps and is the most susceptible to error. Endoscopy costs are dependent on costs of instruments, cleaning costs, and repair costs. The average repair costs at our endoscopy unit remained stable for more than 4 years suggesting a durable life of use. Consideration of endoscope accessories use should consider potential damage to endoscope use, cost to process re-useable items, sterility, and consideration of recent legislation on reprocessing of single-use devices.     

福建省6所省级医院消毒灭菌质量调查

为了解福建省部分省级医院消毒灭菌工作质量,找出医院感染管理过程中存在的问题,采用现场抽检和细菌检测方法进行了调查和实验室检测。结果,物体表面和使用中的消毒液质量全部合格,压力蒸汽灭菌器灭菌质量合格率为100%。室内空气和医护人员手卫生合格率分别为80.65%和78.69%;内窥镜消毒效果合格率为80%,在其中一台不合格胃镜上检测出铜绿假单胞菌。结论,福建省省级医院消毒与灭菌整体质量比较好,但在卫生消毒质量及院感管理上存在薄弱环节,特别是内窥镜消毒效果必须提高。     

不同方法清洗内镜的消毒效果及其监测分析

目的对部分科室内镜清洗消毒效果进行监测,为推广高效清洗消毒方法提供科学依据。方法2005年6月至2006年8月对我院8个科室的内镜分别随机进行3次共161份标本进行细菌学检测。结果本次抽查检测内镜共计161份标本,检出阳性标本32份,阳性率为19.9%。其中,无酶清洗消毒标本84份,监测阳性22份,阳性率为26.2%;含酶清洗消毒标本77份,监测阳性10份,阳性率为13%。含酶清洗消毒与无酶清洗消毒比较,细菌阳性检出率差异有统计学意义(P<0.05)。结论含酶清洗消毒优于无酶清洗消毒,值得临床上进一步推广。     

不同检测方法对内镜消毒效果监测的应用性研究

目的探讨胰蛋白胨葡萄糖培养基(TGEA)法和营养琼脂法对内镜终末漂洗水的监测效果,以及比较试剂盒过滤集菌法和传统过滤集菌法对内镜消毒质量的监测效果。方法调查天津市24家医疗机构内镜中心基本信息,随机抽取终末漂洗水及内镜管腔冲洗水水样,分别采用两种方法检测细菌菌落数。结果 TGEA法对终末漂洗水监测所得检出率(96.7%vs 73.3%)、菌落数(中位数44 CFU/100 ml vs8 CFU/100 ml)均高于营养琼脂法,差异有统计学意义(P 0.05),Bland-Altman分析显示两方法一致性较差;试剂盒过滤集菌法和传统过滤集菌法监测内镜消毒质量检出率(60.0%vs 56.7%)及菌落数(中位数2 CFU/件vs 1 CFU/件)相近,差异无统计学意义(P0.05),Bland-Altman分析显示两方法一致性较好。结论被调查单位对终末漂洗水及内镜消毒质量的监测水平较低、采用检测方法规范性差。TGEA法对终末漂洗水检测更具敏感性、临床适应性强,试剂盒过滤集菌法操作简单、快捷、高效、准确,两种方法均适合内镜中心的日常监测。     

一种全自动内窥镜消毒机杀灭微生物效果的观察

为观察全自动内窥镜消毒机对微生物的杀灭效果 ,采用载体浸泡定量法和模拟现场试验对其消毒效果进行了观察。结果 ,在实验室内以含二氧化氯 2 0 0mg/L的氧氯灵消毒剂水溶液 ,对不锈钢片上金黄色葡萄球菌、大肠杆菌作用 3min ,对白色念珠菌作用 5min杀灭率均达 10 0 % ;含二氧化氯 6 0 0mg/L该液作用 5min ,对枯草杆菌黑色变种芽孢的杀灭率达 10 0 %。模拟现场试验中 ,按规定程序进行加酶清洗、循环消毒 (5min)、臭氧水冲洗和风干等处理程序共 15min ,对污染在各种模拟载体上枯草杆菌黑色变种芽孢的消除率≥ 99.99%。含臭氧量 1.0mg/L的内窥镜冲洗水中未检出存活细菌 ,洗涤剂和消毒剂冲洗水中亦无细菌检出 ;经过清洗、消毒和冲洗后的内窥镜内腔和外壁均未检出二次污染菌。结论 ,该内窥镜采用加酶清洗、二氧化氯消毒和臭氧水冲洗等处理 ,具有良好的消毒效果 ,冲洗水排放符合卫生要求 ,消毒干燥后的窥镜无二次污染现象。